MEDICARE: TRACY HELENA TAYLOR LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	27018771	NY

General Provider Information

NPI Number	:	1699911792
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACY HELENA TAYLOR LMT

Provider Business Mailing Address
First Line	:	4226 FOXWOOD DR
Second Line	:
City	:	WILLIAMSON
State	:	NY
Zip	:	14589-9259
Country	:	US
Telephone Number	:	585-749-3426
Fax Number	:

Provider Business Practice Location Address
First Line	:	595 BLOSSOM RD
Second Line	:	SUITE 307
City	:	ROCHESTER
State	:	NY
Zip	:	14610-1825
Country	:	US
Telephone Number	:	585-749-3426
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/20/2008
Last Update Date	:	12/20/2008

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